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Posted: November 6th, 2022
In healthcare, one of the most critical components of the treatment plan for achieving the greatest possible patient outcomes is involving the patient in decision making. The combination of evidence-based medicine, patient-centered communication skills, and collaborative decision-making is described in Hoffman et al2014 .'s journal paper (Figure 1). In my personal practice, I've seen how including patients in their healthcare decisions has a significant impact on their overall outcome.
Working in an inpatient mental health institution has taught me the importance of involving patients in decision making, even if it can be difficult at times if the patient lacks understanding of the seriousness of their mental condition. I was just able to witness this directly in my facility. We had a patient who had been at our facility for a long time and was classified as profoundly disabled due to mental health issues. When considering what would be best for the patient, the clinician determined that our state mental health facility would be the best option. When the client was informed of this, the patient began ranting and posturing aggressively towards employees, despite the fact that the patient had been nothing but courteous during their month-long stay at our facility. We understood right away that something was awry. We sat down with the patient and asked them to express their emotions. The patient indicated that they did not want to go to the state hospital since they had previously had a negative experience there. The patient went on to say that they had visited this hospital during the peak of COVID and that it seemed like a prison, that they were quarantined to their rooms and were not permitted to have guests. This was a difficult scenario because this client was severely incapacitated, and the state hospital was the greatest alternative for this patient to help manage their disease; but, we did not want it to be a therapeutic option if the client was so resistive to the facility. So we called the state hospital to find out what the status of their COVID limits were, and we discovered that they are far less restrictive than they were the previous time the patient was there. When we informed the patient this, we were able to gradually adapt the patient to the concept of traveling to the state hospital once they were admitted off the waitlist, making the transition much smoother because the patient was eventually excited to go.
This encounter taught me a lot of things. We were ultimately able to get the patient to be more open to going to the state hospital by incorporating the patient's beliefs and values into the decision making regarding their cares. If they are more willing to engage in their treatment, they will have an overall better experience and outcomes at the state hospital. In Krist et al2017 .'s journal post, it is explained how involving patients in care decisions would result in better patient outcomes and more compliance (para. 7). The objective for the patient I mentioned is that because we incorporated their sentiments into the plan, they would be more likely to participate in treatment at the state hospital, which will provide them with the required skills to manage their mental health symptoms outside of a facility setting.
Using The Ottawa Hospital Research Institute's 2019 patient decision aids, I identified the Ottawa Personal Decision Guide as a tool that I could have utilized in both the above-mentioned situation as well as in my personal and professional practice. The tool enables a person to identify their options and the benefits and drawbacks of each. The application also allows the user to identify their expertise, values, and support in reaching this decision. This tool will assist a person in making an informed decision for themselves in a way that allows them to feel included in the decision making, even if the outcome is not what they expected but they were able to weigh the pros and cons and eventually make an informed decision that is best suited for them or at least understand why a treatment team feels it is the best for them.
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